Table 1 Summary of recent literature studies about adrenal insufficiency in critically ill children

Pizarro C (2005) [5]

Septic shock

57 patients

(23 M, 34 F)

Median age:

27 months

High dose ACTH test (250 μg Synacthen)

Cortisol response after ACTH administration (delta cortisol) < 9 μg/dL

Absolute adrenal insufficiency: baseline cortisol < 20 μg/dL

Relative adrenal insufficiency: baseline cortisol > 20 μg/dL

- Catecholamine-resistant shock

- Worsening of multiple organ failure

- High mortality

Menon K (2010) [6]

Major trauma, sepsis, cardiac surgery, general surgery

381 patients (198 M, 183 F);

Median age:

4.01 years

Low dose ACTH test (1 μg Synacthen on day 1)

 + 

High dose ACTH test (1 μg + 250 μg Synacthen on day 2)

Cortisol response after ACTH administration < 9 μg/dL in both tests

- Need for a greater number of catecholamines (P < 0.001),

- Greater number of days on catecholamines (P = 0.002), and more fluid boluses

Hebbar A (2011) [7]

Systemic inflammatory response syndrome (SIRS) secondary to septic shock, Trauma/intracranial

Bleeding, Seizures,

Aspiration pneumonitis, Cardiopulmonary arrest, Pulmonary hypertension, Hemophagocytosis, Cytarabine toxicity, Systemic lupus

Erythematosus, Alveolar dysplasia

78 patients

(45 M, 33 F)

Median age:

84 months

Low dose ACTH test (1 μg Synacthen)

Basal cortisol level < 18 mg/dL

Relative adrenal insufficiency: difference between baseline cortisol and cortisol levels following low-dose ACTH stimulation of < 9 μg/dL

- Hypotension following fluid resuscitation

- Vasopressor-dependent shock

Demiral M (2019) [8]

Various critical illnesses (infections, neurological diseases, cardiac diseases, intoxication, sepsis, renal insufficiency, diabetic ketoacidosis, and autoimmune hemolytic anemia)

100 patients

(45 F, 55 M)

Median age:

7.0 years

Low dose ACTH test (1 μg Synacthen)

Peak cortisol levels < 18 μg/dL or delta cortisol levels < 9 μg/dL following ACTH stimulation

- High underline disease severity

- High mortality risk